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South Dakota rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.47 / $310.47 / $310.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.47 / $385.74 / $479.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $239.78 / $543.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.75 / $434.05 / $537.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.75 / $524.69 / $1,982.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.77 / $293.29 / $515.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.03 / $543.65 / $711.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.50 / $551.30 / $1,038.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.90 / $479.89 / $570.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.80 / $278.63 / $426.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.35 / $484.35 / $484.35